We would be very grateful if you could complete this form after you have carried out any local activity, or series of activities.

The information you provide will help us measure the usefulness of our materials, spread the word in the future, and plan any future steps in the mind out for mental health campaign.

There are two ways to complete this form:

• Fill in the fields on this page and press the 'Submit' button.
• Print out a version of this form to fill in and send by post.

Please complete the fields and checkboxes below:

Brief summary of your activity / activities:

Details of any other groups or organisations that were involved:

Please give brief feedback on your event/s. Roughly how many people were involved? What went well? What didn't? Did you generate any media coverage?:

Website: www.mindout.net	Tick the box if you used this resource
1 useless 2 3 fairly useful 4 5 extremely useful

campaign tags	Tick the box if you used this resource
1 useless 2 3 fairly useful 4 5 extremely useful

campaign leaflets	Tick the box if you used this resource
1 useless 2 3 fairly useful 4 5 extremely useful

z-card (credit card size, fold-out leaflet)	Tick the box if you used this resource
1 useless 2 3 fairly useful 4 5 extremely useful

campaign postcards	Tick the box if you used this resource
1 useless 2 3 fairly useful 4 5 extremely useful

campaign posters	Tick the box if you used this resource
1 useless 2 3 fairly useful 4 5 extremely useful

merchandising unit	Tick the box if you used this resource
1 useless 2 3 fairly useful 4 5 extremely useful

'stop the stigma': local action pack	Tick the box if you used this resource
1 useless 2 3 fairly useful 4 5 extremely useful

working minds: employers' toolkit	Tick the box if you used this resource
1 useless 2 3 fairly useful 4 5 extremely useful

'change your mindset': youth activity pack	Tick the box if you used this resource
1 useless 2 3 fairly useful 4 5 extremely useful

We may wish to publish some of your comments or refer to your activities.

Thank you for feeding back to us about your activities, and our campaign materials.